title: Perioperative conduction disturbances after transcatheter aortic valve replacement.
abstract: Cardiac conduction disturbances after transcatheter aortic valve replacement (TAVR) are common and important. The risk factors and outcome effects of atrial fibrillation after TAVR recently have been appreciated. The paucity of clinical trials has resulted in the absence of clinical guidelines for the management of this important arrhythmia in this high-risk patient population. Given this evidence gap and clinical necessity, it is likely that clinical trials in the near future will be designed and implemented to address these issues. Prompt recognition and proper management of atrioventricular block remain essential in the management of patients undergoing TAVR, because heart block of all types is common and may require permanent pacemaker implantation. The current evidence base has described the incidence, risk factors, and current outcomes of this conduction disturbance in detail. As the practice of TAVR evolves and novel valve prostheses are developed, a focus on minimizing damage to the cardiac conductive system remains paramount. It remains to be seen how the next generation of TAVR prostheses will affect the incidence, risk factors, and clinical outcomes of associated conduction disturbances.
authors.affiliation: Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Kamrouz
authors.initials: K
authors.lastname: Ghadimi
authors.forename: Prakash A
authors.initials: PA
authors.lastname: Patel
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Gutsche
authors.forename: Aris
authors.initials: A
authors.lastname: Sophocles
authors.forename: Saif
authors.initials: S
authors.lastname: Anwaruddin
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.forename: John G T
authors.initials: JG
authors.lastname: Augoustides
mesh_terms: D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006328:Cardiac Catheterization; D006327:Heart Block / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006329:Heart Conduction System / Q000503:physiopathology*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology*
keywords: Edwards Sapien valve; Medtronic CoreValve; Valve Academic Research Consortium; aortic annulus; aortic cusp; atrial fibrillation; balloon valvuloplasty; bundle of His; conduction disturbances; conductive system anatomy; echocardiography; heart block; interventricular septum; left atrial size; left bundle-branch block; left ventricular outflow tract; mitral annular calcification; permanent pacemaker; right bundle-branch block; transcatheter aortic valve implantation